Intended for healthcare professionals

General Practice

Depression as a risk factor for ischaemic heart disease in men: population based case-control study

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1714

Depression and Ischaemic Heart Disease

Hippisley-Cox, Fielding and Pringle have conducted a study in
ischaemic heart disease where it is mostly encountered, in general
practice. They have also followed a line of inquiry often neglected in
secondary and tertiary care, that of the psychological component of
patient risk. The method chosen, a case-control study, is always opened to
criticism because of its retrospective nature and case control matching,
and in the hierachy of evidence resides on a lower rung.

I think the paper should have been titled a general practice based
case-control study as a general practice population and the general
population are not the same. I also was surprised that cholesterol,
identified in the introduction as linked perhaps inversely, to both
ischaemic heart disease and depression, is not included in the analysis as
a confounder. Ditto family history and sedentary lifestyle.

Competing interests: No competing interests

27 November 1998
Mark Nelson
Senior Researcher
Dept of Community Medicine and General Practice, Monash University